Background: Multiple myeloma (MM) is a haematological malignancy characterized by destructive bone lesions, renal injury, anemia and hypercalcemia. Multiple myeloma is a neoplasm that often occurs in adults to the elderly. Complications of pathological fractures occur as a result of lytic lesions of the bone. Complications of MM can appear as a clinical manifestation of the patient so that further examination is needed in patients with pathological fractures to establish MM.

Case: A 67-year-old female patient came to the hospital emergency room accompanied by her family in August 2022 with complaints of pain in her right thigh after falling on the homestairs. The patient has a history of heart disease and hypertension. The patient then underwent an examination and found anemia, an increase in serum creatinine and a complete fracture of the distal 1/3 of the right femur with multiple lytic lesions with decreased bone trabeculation in the skull and pelvis, clavicle, humerus, and femur bilaterally, left costae 7-8^th  with suspected multiple myeloma, differential diagnosis of malignant metastases and vertebral body compression 12^th. Bone survey examination and sampling for histopathological examination were then carried out during the operative management of fractures with the impression of plasmacytosis so that the patient was diagnosed with Post ORIF PS, bone graft and post biopsy e.c. pathological fracture right supracondylar femur with multiple lytic lesions e.c. multiple myeloma. The patient was then referred to the orthopedic oncology department.

Conclusion: Patients with pathological fracture manifestations need to be investigated further regarding the underlying cause of the condition. Multiple myeloma is one of the hematological malignancies that can cause bone lesions due to an imbalance of bone destructive factors so that it can increase the risk of pathological fracture complications. Knowing the complications, clinical manifestations and supporting characteristics of multiple myeloma can help in making the diagnosis of myeloma in patients with pathological fractures.

Latar belakang: Mieloma multipel (MM) adalah keganasan hematologi yang ditandai dengan lesi tulang yang destruktif, cedera ginjal, anemia dan hiperkalsemia. Mieloma multipel merupakan neoplasma yang sering terjadi pada orang dewasa hingga lanjut usia. Komplikasi fraktur patologis terjadi akibat lesi litik pada tulang. Komplikasi MM dapat muncul sebagai manifestasi klinis pasien sehingga perlu dilakukan pemeriksaan lanjutan pada pasien fraktur patologis untuk menegakkan MM.

Laporan Kasus: Pasien perempuan berusia 67 tahun datang ke IGD Rumah Sakit diantar oleh keluarganya pada Agustus 2022 dengan keluhan nyeri pada paha kanan setelah terjatuh di tangga rumah. Pasien memiliki Riwayat penyakit jantung dan hipertensi. Pasien kemudian melakukan pemeriksaan dan ditemukan kondisi anemia, peningkatan serum kreatinin dan fraktur komplit 1/3 distal os femur kanan dengan lesi litik multipel dengan penurunan trabekulasi tulang pada skull dan pelvis, os klavikula, humerus, dan femur bilateral, costae 7-8 kiri dengan suspek mieloma multipel diagnosis banding metastasis keganasan dan kompresi korpus vertebra 12. Pemeriksaan survei tulang dan pengambilan sampel untuk pemeriksaan histopatologi kemudian dilakukan saat tatalaksana operatif penanganan fraktur dengan kesan plasmasitosis sehingga pasien didiagnosis  dengan Post ORIF PS dan pemasangan bone graft dan pasca biopsi e.c. pathological fracture right supracondylar femur with multiple lytic lesion e.c. multiple myeloma. Pasien kemudian dirujuk ke bagian orthopaedi onkologi.

Simpulan: Pasien dengan manifestasi fraktur patologis perlu dilakukan pemeriksaan lebih lanjut mengenai penyebab yang mendasari keadaan tersebut. Mieloma multipel menjadi salah satu keganasan hematologi yang dapat menimbulkan lesi tulang akibat ketidakseimbangan faktor destruktif tulang sehingga dapat meningkatkan risiko komplikasi fraktur patologis. Mengetahui komplikasi, manifestasi klinis dan penunjang yang menjadi karakteristik dari mieloma multipel dapat membantu dalam menegakkan diagnosis mieloma pada pasien dengan fraktur patologis.

Background: Keloids are soft solid tumors with a smooth surface that extend beyond the wound margins and invade adjacent normal tissue. Appears at the age of 10-30 years, occurs as a result of an imbalance between increased collagen synthesis and extracellular matrix. There are several types of therapeutic modalities such as intralesional or topical corticosteroids, surgical excision, electrosurgery, frozen surgery, radiotherapy and laser therapy. Combination therapy of surgical excision and intralesional corticosteroids used for this case.

Case Description: A woman, 43 years old, complained since 3 years ago, in the lower left abdomen there is a lump, which has been getting bigger over the past 1 year, sometimes feels pain and itching. In the left inferior abdominal region, multiple tumors were found to be erythematous to hyperpigmented, with firm boundaries, oval in shape, 0.2 cm to 0.5 cm in diameter, with a length and width of 0.3 cm and 0.5 cm, respectively. 1 cm and 1.5 cm, the surface feels smooth and shiny. On palpation, the tumor was fixed and firm in consistency. Surgical excision was performed and continued with intralesional injection of triamcinolone acetonide once a week on keloid and post-excision lesions. There was clinical improvement of keloids, on the 21st day of observation.

Conclusion: Surgical excision is minimally invasive and can be combined with weekly intrakeloid triamcinolone acetonide injection therapy for keloid lesions and post-excision area to reduce the risk of new keloids appearing. On follow-up observation of keloids in the left inferior abdominal region, the lesion was getting smaller and softened and there was no new keloid growth in the post-excision area.

Latar belakang: Keloid adalah tumor yang padat lunak, dengan permukaan licin berkembang melebihi batas luka dan menginvasi jaringan normal yang berdekatan. Muncul pada usia 10-30 tahun, terjadi akibat dari ketidakseimbangan antara peningkatan sintesis kolagen dan matriks ekstraseluler. Terdapat beberapa macam modalitas terapi seperti kortikosteroid intralesi atau topikal, bedah eksisi, bedah listrik, bedah beku, radioterapi dan terapi laser. Kasus ini membahas terapi kombinasi bedah eksisi dan kortikosteroid intralesi.

Kasus: Seorang wanita, berusia 43 tahun, mengeluh sejak 3 tahun yang lalu, pada perut kiri bawah terdapat benjolan, yang semakin lama semakin membesar selama 1 tahun terakhir, rasa nyeri dan gatal terkadang dirasakan. Pada regio abdominalis inferior sinistra ditemukan tumor multipel berwarna eritema sampai hiperpigmentasi, dengan batas yang tegas, berbentul bulat oval, berdiameter 0,2 cm sampai 0,5 cm, dengan panjang dan lebar masing-masing 0,3 cm dan 0,5 cm serta 1 cm dan 1,5 cm, permukaan teraba licin dan mengkilat. Pemeriksaan palpasi ditemukan tumor terfiksir dan konsistensinya keras. Dilakukan tindakan bedah eksisi dan dilanjutkan dengan injeksi triamsinolon asetonid intralesi seminggu sekali pada lesi keloid dan lesi paska eksisi. Terdapat perbaikan klinis keloid, pada pengamatan hari ke-21.

Simpulan: Tindakan invasif minimal seperti bedah eksisi dapat dikombinasi dengan injeksi triamsinolon asetonid intrakeloid seminggu sekali pada lesi keloid dan daerah paska eksisi untuk mengurangi risiko munculnya keloid baru. Pada pengamatan lanjutan keloid pada regio abdominalis inferior sinistra, didapatkan lesi semakin mengecil dan melunak dan tidak terdapat pertumbuhan keloid baru pada daerah paska tindakan eksisi.

Background: Sebaceous gland hyperplasia is a benign skin disorder in the form of macules or papules which are generally < 1 mm in size, skin color or yellowish at the mouth of the pilosebaceous gland follicle.1 This disorder can cause cosmetic morbidity and psychosocial impacts for patients. There are various treatment modalities for sebaceous gland hyperplasia associated with the risk of pain, depigmentation, bleeding during the procedure, scarring, and recurrence. CO2 laser is one of the therapeutic approaches that are considered effective and safe.

Case: A female patient came with the chief complaint of lumpy skin-colored lumps on the back of the ear to the left neck that had increased in number and had not been painful since about 4 years ago. Histopathological examination was performed on the lump showing hyperplasia of the sebaceous glands. The patient was treated with 2 CO2 Laser sessions with an even skin surface result. Observations made within 9 months after the procedure did not reveal any recurrence of the lesion.

Conclusion: CO2 laser can be an effective and safe alternative therapy for sebaceous gland hyperplasia.

Latar Belakang: Hiperplasia kelenjar sebasea adalah kelainan jinak kulit berupa makula atau papula yang umumnya berukuran < 1 mm sewarna kulit atau kekuningan di muara folikel kelenjar pilosebasea.¹ Kelainan ini dapat menimbulkan morbiditas kosmetik dan dampak psikososial bagi pasien. Terdapat berbagai modalitas tatalaksana hiperplasia kelenjar sebasea yang berhubungan dengan risiko nyeri, depigmentasi, perdarahan selama prosedur, skar, hingga kekambuhan. Laser CO2 merupakan salah satu pendekatan terapi yang dianggap efektif dan aman.

Kasus: Pasien wanita datang dengan keluhan utama benjolan bergerombol sewarna kulit pada telinga bagian belakang hingga leher kiri yang bertambah banyak dan tidak nyeri sejak kurang lebih 4 tahun yang lalu. Pemeriksaan histopatologi dilakukan pada benjolan menunjukkan hasil hiperplasia kelenjar sebasea. Pasien diterapi dengan 2 sesi Laser CO2 dengan hasil permukaan kulit rata. Observasi yang dilakukan dalam 9 bulan paska tindakan tidak didapatkan rekurensi pada lesi.

Simpulan: Laser CO2 dapat menjadi alternatif terapi pada hiperplasia kelenjar sebasea yang efektif dan aman.

Background: Dengue hemorrhagic fever (DHF) occurs due to plasma leakage due to increased vascular permeability, which is also supported by an active complement system, which makes DHF fall into complications such as shock or dengue shock syndrome (DSS). The comprehensive management of DSS could prevent morbidity and mortality in patients. We aimed to report three variations of dengue shock syndrome cases and their management.

Case presentation: Three cases of DSS from our hospital. Two case reports with clinical dengue fever patients with shock and one case report with clinical dengue patients with shock and complications of acute liver failure. The first case was a 24 years olds male patient with classic signs of dengue fever plus spontaneous bleeding in the form of nosebleeds accompanied by hemodynamic disturbances. Laboratory examination revealed severe thrombocytopenia. In the second case, a male patient with dengue shock syndrome accompanied acute liver failure. The patient complains of heartburn and nausea accompanied by tea-like urine. Dengue patients with abdominal pain typical of liver disorders, nausea, vomiting and anorexia, and hepatomegaly with or without jaundice are typical of liver disorders. The third case, a male patient with dengue shock syndrome, accompanied the suspicion of ascites. The main treatment is the administration of isotonic crystalloid fluids according to body weight. While in cases of acute liver failure, NAC can be given.

Conclusion: We found three cases of DSS with some complications. It is important to know the right treatment immediately so that complications do not occur.

Background: Basal cell carcinoma is one of the most common classifications of non-melanoma skin cancer (75% - 80%) of all cancers. Basal cell carcinoma causes widespread local destruction including soft tissue, cartilage, and bone, thus impairing function and aesthetics, especially for the facial area. One of the most common reconstructive techniques for Basal Cell Carcinoma is the Rhomboid flap. This case report aims to report the use of the rhomboid flap reconstruction technique in post-wide excision of basal cell carcinoma.

Case Description: A man, 54 years old, ethnic Balinese, came to the General Surgery Clinic of RSUD Klungkung with a complaint that a mole on the patient's left eye appeared enlarged with itching and bleeds easily. These complaints began to be felt since about 2 weeks before entering the hospital. Initially the patient's mole had been there for 5 years, previously the patient had no complaints about the mole, the initial lesion was in the form of a small brownish lump which was then felt to be getting bigger with itching and bleeding easily. The patient did not complain of pain. Examination of the localized status on the lateral periorbital sinistra showed blackish nodules with hyperpigmented macules, solitary, 2cm x 1cm in size, visible erosions, well-defined borders, irregular shape.

Conclusion: The provisional diagnosis of Suspected Malignant Skin Tumor was established based on history, physical examination, with management therapy wide excision and reconstruction with Rhomboid Flap followed with biopsy.

Latar Belakang : Karsinoma Sel Basal (KSB) adalah salah satu kanker kulit  yang paling sering ditemukan dari seluruh kanker kulit non melanoma.  Karsinoma Sel Basal dapat mengakibatkan kerusakan local dengan infiltrasi yang luas sehingga mengganggu fungsi dan estetika, terutama untuk daerah wajah. Salah satu pilihan  teknik rekonstruksi yang bisa dilakukan pada Karsinoma Sel Basal di regio wajah  adalah Rhomboid flap. Laporan kasus ini bertujuan untuk melaporkan penggunaan tehnik rekonstruksi dengan flap rhomboid pada pasca eksisi luas pada karsinoma sel basal.

Deskripsi Kasus: Seorang laki-laki, 54 tahun, suku Bali,  datang ke Poliklinik bedah Umum RSUD Klungkung dengan keluhan tahi lalat pada sebelah mata kiri pasien tampak membesar disertai gatal dan mudah berdarah. Keluhan tersebut mulai dirasakan sejak sekitar 2 minggu sebelum masuk RS. Awalnya tahi lalat pasien sudah ada sejak 5 tahun yang lalu, sebelumnya pasien tidak ada keluhan pada tahi lalat tesebut, lesi awal berupa benjolan kecil berwarna kecoklatan yang kemudian makin lama dirasakan makin membesar disertai rasa gatal dan mudah berdarah. Keluhan nyeri tidak dikeluhkan oleh pasien.  Pemeriksaan status lokalis pada periorbital lateral S tampak nodul kehitaman disertai makula hiperpigmentasi, soliter, ukuran 2cm x 1cm, tampak erosi, batas tegas, bentuk tidak beraturan.

Kesimpulan: Diagnosis sementara Tumor Kulit Suspek Malignant ditegakkan berdasarkan anamnesis, pemeriksaan fisik dengan terapi eksisi luas + biopsi + rekonstruksi dengan Rhomboid Flap.

Background: Alopecia universalis is an autoimmune disease of the hair follicles, which results in complete loss of head and body hair. Until now there is no proven effective therapy in dealing with this disease. We report a case of alopecia universalis that responded well to combination therapy.

Case: Female, 22 months old, complained by her parents due to hair loss on her head, eyebrows and eyelashes that had not grown back since the age of 8 months. On the fingernails and toenails found pitting nails, trachonycia. On scalp dermoscopy examination, multiple yellow dots were found. Severity of Alopecia Tool Score (SALT) was 100%. The patient was treated with minoxidil 5%, mometasone 0.1%, triamcinolone 12 mg and excimer laser. Administration of minoxidil increases prostaglandin production and maintains the anagen phase. Corticosteroids are immunosuppressive which suppress the immune attack of T cells on hair follicles. UV light on the excimer laser can reduce the proliferation of T lymphocytes, thereby reducing perifollicular inflammation and hair follicle damage. In this case, after 4 months of observation, the growth of terminal hair and vellus hair on the scalp, eyebrows and eyelashes was seen. On the patient's nails, the trachonycia was improved, with pitting nails remaining. SALT decreased to 58%.

Conclusion: The combination therapy of minoxidil, corticosteroid and excimer laser gave good results in this case. During treatment, there were no side effects or recurrences.

Latar belakang : Alopesia universalis adalah penyakit autoimun pada folikel rambut, yang mengakibatkan kerontokan seluruh rambut kepala dan tubuh. Hingga saat ini belum ada terapi yang terbukti efektif dalam menangani penyakit ini. Berikut dilaporkan kasus alopesia universalis yang memberikan respon baik dengan terapi kombinasi.

Kasus: Pasien perempuan, 22 bulan, dikeluhkan orang tuanya mengalami rambut kepala, alis dan bulu mata yang rontok dan tidak tumbuh kembali sejak usia 8 bulan. Pada kuku tangan dan kaki didapatkan adanya pitting nails, trachonycia. Pada pemeriksaan dermoskopi kulit kepala didapatkan adanya multiple yellow dots. Severity of Alopecia Tool Score (SALT) 100%. Pasien diberikan terapi minoksidil 5%, mometason 0.1%, triamsinolone 12 mg dan laser excimer. Pemberian minoksidil meningkatkan produksi prostaglandin dan mempertahankan fase anagen. Kortikosteroid bersifat imunosupresif yang menekan serangan imunitas sel T pada folikel rambut. Sinar UV pada laser excimer dapat menurunkan proliferasi sel T limfosit sehingga mengurangi peradangan perifolikular dan kerusakan folikel rambut. Pada kasus, setelah pengamatan selama 4 bulan nampak adanya pertumbuhan rambut terminal dan rambut vellus pada kulit kepala, alis dan bulu mata. Pada kuku pasien nampak trachonycia membaik, tersisa pitting nails. SALT menurun menjadi 58%.

Simpulan: Terapi kombinasi minoksidil, kortikosteroid dan laser excimer memberikan hasil yang baik pada kasus ini. Selama pengobatan tidak didapatkan adanya efek samping dan rekurensi.

Background: A pediatric traumatic cataract is one of the children's main causes of unilateral visual impairment. It is defined as a permanent opacification of the lens caused by penetrating or blunt trauma to the eye, which might damage the vision. A traumatic pediatric cataract is preventable and treatable. This case study aims to evaluate a neglected case of blunt eye injury leading to pediatric cataracts.

Case Description: A 15-year-old boy came with chief complaints of decreased visual acuity in his left eye for the last 2 years. He has a history of blunt eye injury around 3 years prior in the left eye but left untreated. The patient's visual acuity was 1 per light perception in the left eye. An ophthalmologic examination of the left eye showed an opacity in the lens. The posterior segment cannot be examined. The patient was assessed with a traumatic cataract and was planned to be operated on, but the parents refused.

Conclusion: Prompt first aid and timely surgical intervention are necessary for optimal results. Parents play a critical role in the patient's prognosis by observing closely after eye trauma and bringing their children to the right medical facility.

Since the beginning, genital hygiene has become a concern for women susceptible to infections of the urinary tract and reproductive system where the vagina is an unsterile organ related to external exposure and close to the anus. Several problems related to the personal hygiene of female genitalia arise due to a lack of understanding and literature discussing this matter. This literature review will discuss the normal flora of the female genitalia and procedures for daily vaginal care, which aims to increase understanding of female genital personal hygiene.

Sejak dahulu hygiene genetalia sudah menjadi perhatian kaum wanita, karena wanita sangat rentan terkena infeksi traktus urinarius dan sistem reproduksi dimana vagina merupakan organ yang tidak steril yang berhubungan dengan dunia luar serta berdekatan dengan anus. Beberapa masalah terkait personal hygiene genitalia wanita timbul akibat kurang pemahaman dan sedikitnya literatur yang membahas tentang hal ini. Tinjauan pustaka ini akan membahas mengenai flora normal genitalia wanita dan tata cara perawatan vagina sehari-hari yang bertujuan untuk meningkatkan pemahaman terhadap personal hygiene genitalia wanita.

A number of facelift procedures have been introduced by many surgeons but there is no consensus has yet been established to carry. Since the first description of superficial musculoaponeurotic system (SMAS), it is used as the basis for many facelift methods that produce superior result in rejuvenation compared to traditional skin only facelift. Extended SMAS facelift becoming SMAS modification techniques that is still being developed. It produces two different vector of subcutaneous and SMAS flap, that is essential to restore drooping deep facial tissue with natural appearance. Despite the beneficial use of extended SMAS flap, most of plastic surgeons still traditionally incise the SMAS under the zygomatic arch. However, the low SMAS incision results only on rejuvenation of the lower face and is not sufficient to correct mid-facial aging. Fundamental concepts of high SMAS facelift by  reviewing some literatures explain that high SMAS flap transection allowing the surgeon to achieve greater vertical elevation of the deep structures of the face by undermining the middle face, combined with fixation to a fixed structure produces lasting results and oblique vector of skin envelope creating no tension look. Incision above zygomatic arch turns out to be safely performed without facial nerve injury thorough knowledge of the anatomy. The final result is a balanced and harmonious elevation of sagging tissues of the midface, cheek, and jawline, to such an extent that high SMAS facelift becomes optimal, durable, technically simple, reproducible and with a comparatively high safety margin in facelift procedures.

Background: Since March 2020, Coronavirus Disease 2019 (COVID-19) has been declared a pandemic. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) underwent genetic evolution and changes in the nature of the virus, clinical manifestations, and response to treatment. This study aims to determine the profile of hospitalized COVID-19 patients at  Ari Canti Hospital (RSAC), one of the COVID-19 referral hospitals in Gianyar, Bali.

Methods: The design was a descriptive cross-sectional retrospective study, using the medical records of confirmed COVID-19 by Real Time Polymerase Chain Reaction (RT-PCR) patients selected by a simple random sampling technique.

Results: From 290 samples, the majority of COVID-19 patients treated at RSAC were 60.7% male, in the age range of 50-59 years 26.5%, with severe symptoms 45.8% and recovered 83.4%. The dominant symptoms were fever 85.2%, cough 80%, and shortness of breath 60%. The most common comorbidities were >1 comorbidity, hypertension, and diabetes mellitus. Hematological examination at the first time of hospitalization showed leukopenia (4.8%), lymphopenia (14.5%), thrombocytopenia (12.8%),  and anemia (21.7%). The results also showed an increase in Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer  (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP)  (66.6%). Most showed bilateral infiltrates on chest x-ray. The most common treatment for COVID-19 at RSAC uses antiviral remdesivir (77.9%), quinolone antibiotics (73.4%), and Low Molecular Weight Heparin (LMWH) (53.4%).  A total of 56.6% of patients received corticosteroid therapy.

Conclusion: Patients hospitalized at RSAC mostly showed severe symptoms and recovered. The treament folowing the standard of inpatient treatment for COVID-19 patients.

Latar belakang: Sejak Maret 2020, Coronavirus Disease 2019 (COVID 19) dinyatakan sebagai pandemi. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mengalami evolusi genetik dan perubahan sifat virus, manifestasi klinis serta respon pengobatan. Penelitian ini bertujuan untuk mengetahui profil pasien COVID-19 yang dirawat di Rumah Sakit Ari Canti (RSAC), salah satu rumah sakit rujukan COVID-19 di Gianyar, Bali

Metode: Rancangan penelitian ini adalah cross-sectional deskriptif retrospektif, menggunakan rekam medis pasien terkonfirmasi COVID-19 dengan Real Time Polymerase Chain Reaction (RT-PCR) sejak Juli 2020 - Maret 2022 yang dipilih dengan teknik simple random sampling.

Hasil: Dari 290 sampel, mayoritas pasien COVID-19 yang dirawat di RSAC adalah laki-laki 60.7%, berada pada rentang usia 50-59 tahun 26.5%, dengan gejala berat 45.8% dan sembuh 83.4%. Gejala didominasi demam 85.2%, batuk 80%, dan sesak 60%. Komorbid tersering yaitu >1 komorbid, hipertensi, dan diabetes melitus. Gambaran hematologi menunjukkan leukopenia (4.8%), limfopenia (14.5%), trombositopenia (12.8%), dan  anemia (21.7%). Hasil juga menunjukkan peningkatan Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP) (66.6%). Sebagian besar menunjukkan infiltrat bilateral pada x-ray thorax. Tatalaksana COVID-19 di RSAC tersering menggunakan antivirus remdesivir (77.9%), antibiotik golongan kuinolon (73.4%), dan antikoagulan Low Molecule Weight Heparin (LMWH) (53.4%). Sebanyak 56.6 % pasien mendapat terapi kortikosteroid.

Kesimpulan: Pasien COVID-19 yang dirawat di RSAC sebagian besar menunjukkan gejala berat dan sembuh. Terapi yang diberikan mengikuti standar terapi rawat inap pasien COVID-19.

Background. Sustainable Development Goals (SDGs) targets the decrease of neonatal mortality rate until 12 per 1.000 live birth. One of the neonatal death’s causes is premature baby which is related to the low birth weight (LBW) infant. The incidences of LBW were 15%-20% and almost 95% of those were born in developing countries. The aim of this study is to know several risk factors that related to the incidences of LBW infant in Regional Public Hospital Negara.

Material. This case control study was conducted in September 2021. The subjects were inpatient babies in Perinatology ward and was born in Regional Public Hospital Negara, from 01 January 2020 to 30 December 2020. Consecutive sampling and gender matching were performed for the subjects selection. There are 42 sampels that match to the inclusion and exclusion criteria for each group. The data of risk factors and LBW were collected from the medical record. Statistical analyses included McNemar and logistic regression using SPSS v22 software with p<0,05

.

Results. Bivariate statistical analyses results from LBW’s risk factors were p value=0.001 for gestational age, p value=0.031 for parity, p value= 0.049 for anemia during pregnancy, p value=0.267 for maternal age, p value=1.000 history of LBW before, p value=0.344 for miscarriage history, and p value=0.804 for preeclampsia. Meanwhile, multivariate statistical analyses showed that gestational age risk factor, p value=0,001 (OR=44,97; 95%IC: 8,44-239,75) and parity risk factor, p value=0,011 (OR=5,04: 95%IC: 1,44-17,66) were the risk factors that related to the incidences of LBW infant in Regional Public Hospital Negara

Conclusion. Gestational age and parity were the risk factors that related to the incidences of LBW infant in Regional Public Hospital Negara

Latar Belakang : Sustainable Development Goals (SDGs) memfokuskan penurunan angka kematian neonatus hingga 12 per 1.000 kelahiran hidup. Salah satu penyebab utama kematian pada neonatus di dunia adalah bayi prematur yang merupakan komponen dalam bayi berat lahir rendah (BBLR). Angka kejadian BBLR sekitar 15%-20% dari seluruh kelahiran dan hampir 95% BBLR terjadi di Negara berkembang. Penelitian ini bertujuan untuk mengetahui beberapa faktor risiko yang berhubungan dengan kejadian BBLR di Rumah Sakit Umum Daerah (RSUD) Negara.

Metode : Penelitian ini adalah penelitian kasus kontrol yang dilakukan pada bulan September 2021. Penelitian ini melibatkan bayi lahir hidup di RSUD Negara yang dirawat di ruang Perinatologi RSUD Negara mulai 01 januari 2020 - 30 Desember 2020. Pengambilan sampel menggunakan metode consecutive sampling dan dilakukan matching jenis kelamin. Sampel yang memenuhi kriteria inklusi dan eksklusi adalah 42 sampel kasus dan 42 sampel kontrol. Data faktor risiko dan BBLR di ambil dari catatan rekam medis. Uji statistik menggunakan uji McNemar dan regresi logistik dengan perangkat lunak SPSS versi 22 dengan batas nilai p <0,05.

Hasil : Uji statistik bivariat terhadap BBLR menemukan bahwa faktor risiko usia gestasi p=0,001, paritas p=0,031, anemia ibu p=0,049, faktor risiko usia ibu p=0,267, faktor risiko riwayat melahirkan anak BBLR p=1,000, faktor risiko riwayat abortus p=0,344, dan faktor risiko preeklampsia p=0,804. Sementara itu, uji Satistik multivariat menemukan bahwa faktor usia gestasi, nilai p=0,001 (OR=44,97; 95%IK: 8,44-239,75) dan faktor risiko paritas, nilai p=0,011 (OR=5,04: 95%IK: 1,44-17,66) merupakan faktor risiko kejadian BBLR di RSUD Negara.

Background: Malignant pleural effusion carries a bad prognosis. Pathologic examination as the gold-standard diagnosis of malignant pleural effusion has sensitivity limitations and may cause delayed diagnosis. Several affordable examinations, such as serum pleural effusion albumin gradient, total protein, lactate dehydrogenase (LDH), and erythrocyte count, might be useful as malignant pleural effusion diagnostic tools.

Methods: This is an observational analytic study with a cross-sectional design conducted at Sanglah Central General Hospital in Denpasar from December 2021 to July 2022. Pleural effusion fluid and blood were taken from subjects with malignant and non-malignant pleural effusion. Data were analyzed with SPSS version 25 software for Windows.

Results: Total subjects were 47 persons consisting of 26 subjects with malignant pleural effusion and 21 subjects with non-malignant pleural effusion. Results from statistical analysis of malignant and non-malignant pleural effusion were serum pleural effusion albumin gradient median (IQR) 0.91 (0.65) g/dL vs. 1.22 (1.2) g/dL (p=0.129), total protein mean 3.92±0.95 g/dL vs. 3.52±1.67 g/dL (p=0.334), LDH median 535 (840) IU/L vs. 187 (1,016) IU/L (p=0.057), and erythrocyte count median 23,500 (109,250) cells/mm³ vs. 3,000 (11,000) cells/mm³ (p=0.004). The AUC of erythrocyte count from the ROC method was 0.745 (95%CI=0.599-0.890; p=0.004). Using a cut-off point ≥ 4,500 cells/mm³, it had a sensitivity of 80.8%, specificity of 61.9%, and Odds Ratio (OR) of 6.8 (95%CI=1.8-25.4).

Conclusion: Erythrocyte count as routine examination showed good validity for diagnosing malignant pleural effusion and expected to reduce diagnosis delay. Meanwhile, albumin gradient, total protein, and LDH delivered no difference.

Background: Coronavirus disease (COVID-19) infection has become a worldwide pandemic. Diabetes Mellitus is a comorbid disease that can increase in severity. The most common clinical finding in severe COVID-19 infection is a high Neutrophil Lymphocyte Ratio (NLR). In patients with Diabetes Mellitus (DM) type 2, it is also known that high NLR values ​​have a poor prognosis. This study analyzes the risk factors associated with high NLR values ​​in type 2 DM patients infected with COVID-19 at Sanglah General Hospital.

Methods: A cross-sectional analytical study was conducted on the medical records of 70 patients with COVID-19 infection with type 2 DM who were treated at Sanglah General Hospital, Denpasar, for the period April 2020-October 2020. The samples were divided into two groups, namely high and normal NLR. The analysis was conducted to see which risk factors were significantly associated with high NLR values ​​in COVID-19 patients with type 2 diabetes. The analysis was carried out using an independent T-test for numerical variables and chi-square for nominal variables.

Results: Most of the study samples had high levels of NLR (65.71%). Risk factors that had a significant relationship with high NLR values ​​were random blood sugar levels (p=0.00), fasting blood sugar levels (p=0.00), HbA1c (p=0.002), CRP levels (p=0.00), leukocyte level (p=0.00), BUN level (p=0.004), history of type 2 DM before COVID-19 infection (p=0.009) and control HbA1c (0.001).

Conclusion: The risk factors associated with high NLR values ​​in COVID-19 patients with type 2 DM at Sanglah Hospital Denpasar are random blood sugar levels, fasting blood sugar levels, HbA1c, CRP levels, leukocyte levels, BUN levels, history of type 2 diabetes before COVID-19 infection and HbA1c control.

Latar Belakang: Infeksi Coronavirus disease (COVID-19) telah menjadi pandemik di seluruh dunia. Diabetes Mellitus merupakan penyakit komorbid yang dapat meningkatkan keparahan. Temuan klinis yang banyak ditemukan pada infeksi COVID-19 berat adalah nilai neutrophil lymphocyte ratio (NLR) yang tinggi. Pada pasien Diebetes Mellitus (DM) tipe 2 juga diketahui nilai NLR yang tinggi memiliki prognosis buruk. Penelitian ini bertujuan untuk menganalisis faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien DM tipe 2 yang terinfeksi COVID-19 di RSUP Sanglah.

Metode: Studi analitik potong lintang dilakukan pada rekam medik 70 pasien dengan infeksi COVID-19 dengan DM tipe 2 yang dirawat di RSUP Sanglah Denpasar periode April 2020-Oktober 2020. Sampel dibagi menjadi dua kelompok yakni NLR tinggi dan normal. Analisis dilakukan untuk melihat faktor risiko yang signifikan berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2. Analisis dilakukan menggunakan uji independent T-test untuk variabel numerik dan chi-square untuk variabel nominal.

Hasil: Mayoritas sampel penelitian memiliki kadar NLR tinggi (65,71%). Faktor risiko yang memiliki hubungan signifikan dengan nilai NLR tinggi adalah kadar gula darah acak (p=0,00), kadar gula darah puasa (p=0,00), HbA1c (p=0,002), kadar CRP (p=0,00), kadar leukosit (p=0,00), kadar BUN (p=0,004), riwayat DM tipe 2 sebelum infeksi COVID-19 (p=0,009) dan kontrol HbA1c (0,001).

Kesimpulan: Faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2 di RSUP Sanglah Denpasar adalah kadar gula darah acak, kadar gula darah puasa, HbA1c, kadar CRP, kadar leukosit, kadar BUN, riwayat DM tipe 2 sebelum infeksi COVID-19 dan kontrol HbA1c.

Background: In Indonesia, the incidence of breast cancer is 42,1 per 100,000 people, whereas the average mortality rate is 17 per 100,000 people. 8-10% of women with breast cancer will experience locoregional recurrence, and 15-30% may develop distant metastases. This study aimed to examine if cancer subtypes, histological grading, and LVI were linked with breast cancer recurrence in patients after Modified Radical Mastectomy at Prof. RSUP. Dr. I G.N.G. Ngoerah.

Methods: Medical record data are used as the study data source to discover the factors that impact breast cancer recurrence in patients who have had a modified radical mastectomy. This research was done using a sequential sampling method. This study's sample utilized inclusion and exclusion criteria to generate 363 patients. The data obtained were analyzed using SPSS ver 22.

Results: The results revealed that 327 patients, or 90.1%, did not have a recurrence, whereas 36 patients, or 9.9%, did. There were 50 Luminal A subtype patients, 127 Luminal B subtype patients, 61 Luminal-Her2 subtype patients, 65 Her2 subtype patients, and 60 TNBC subtype patients. 231 individuals were found to have a negative LVI, whereas 132 patients had a positive LVI. Forty-seven individuals were diagnosed with grade I, 174 with grade II, and 142 with grade III. Breast cancer recurrence was significantly impacted by LVI (p<0.05).

Conclusion: LVI is strongly related to breast cancer recurrence in patients undergoing Modified Radical Mastectomy, but subtype and histological grading are not.

Latar Belakang: Angka kejadian kanker untuk kanker payudara di Indonesia sebesar 42,1 per 100.000 penduduk dengan rata-rata kematian sebesar 17 per 100.000 penduduk. Antara 8-10% wanita yang didiagnosis dengan kanker payudara akan mengalami kekambuhan locoregional dan 15-30% akan mengalami metastasis jauh. Tujuan penelitian ini dilakukan yaitu untuk mengetahui apakah subtipe kanker, grading histopatologi dan LVI menjadi faktor yang berhubungan dengan terjadinya rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy di RSUP Prof. Dr. I G.N.G Ngoerah.

Metode: Desain penelitian cross sectional digunakan dalam penelitian ini, dimana data rekam medis menjadi sumber data penelitian. Penelitian menggunakan pengambilan sampel secara konsekutif. Sampel dalam penelitian menggunakan kriteria inklusi dan eksklusi dan diperoleh jumlah sampel 363 pasien. Data yang didapatkan dianalisis dengan menggunakan SPSS ver 22.

Hasil: Hasil penelitian menunjukkan sebanyak 327 pasien atau sebesar 90,1% tidak rekuren, sedangkan 36 pasien atau sebesar 9,9% mengalami rekurensi. Terdapat 50 pasien dengan subtipe Luminal A, 127 pasien dengan subtipe Luminal B, 61 pasien dengan subtipe Luminal-Her2, 65 pasien dengan subtipe Her2, dan 60 pasien dengan subtipe TNBC. Dari 231 pasien didapatkan dalam kategori LVI negatif, sedangkan 132 pasien memiliki LVI positif. Sebanyak 47 pasien didapatkan dengan grade I, 174 pasien dengan dengan grade II, dan 142 pasien memiliki grade III. LVI memiliki pengaruh signifikan (p<0,05) terhadap rekurensi kanker payudara.

Simpulan: LVI berhubungan signifikan terhadap rekurensi kanker payudara pada pasien pasca Modified Radical Mastectomy, sedangkan subtipe dan grading histopatologis tidak.

Background: Anosmia and ageusia are early symptoms that are widely reported in COVID 19 patients and are associated with low rates of intensive care and mortality, so the hypothesis arises that anosmia and ageusia can be good prognostic factors in COVID-19 patients. This study aims to examine anosmia and ageusia as prognostic factors in COVID-19 patients.

Methods: This study is an observational analytic study with a retrospective cohort design conducted at Sanglah General Hospital Denpasar from January to June 2022.

Results: obtained a total of 1048 subjects with 344 subjects experiencing anosmia, 210 subjects experiencing ageusia, and 474 subjects experiencing a combination of anosmia and ageusia. Variable symptoms of anosmia and ageusia were statistically significant predictors for the recovery of COVID-19 patients (p<0.05). The cure rate in the group of patients with symptoms of anosmia was 1.8 times (RR = 1.783, 95% CI = 1.667-1.908) and the group of patients with symptoms of ageusia experienced 1.6 times higher recovery (RR = 1.564, 95% CI = 1.478 -1,655). After adjusting for other variables as confounders, the combination of symptoms of anosmia and ageusia in patients was a significant predictor of recovery for COVID-19 patients by 1.5 times compared to patients who did not experience the combination of symptoms of anosmia and ageusia (ARR = 1.523, 95% CI = 1.245- 1.864, p<0.05).

Conclusion: Anosmia, ageusia and the combination of both, indicate protective factors against possible mortality and indicate a good prognosis in COVID-19 patients.

Latar belakang: Anosmia dan ageusia merupakan gejala awal yang banyak dilaporkan pada pasien COVID-19 serta dikaitkan dengan tingkat rawat intensif dan mortalitas yang rendah sehingga muncul hipotesis bahwa anosmia dan ageusia dapat menjadi faktor prognosis yang baik pada pasien COVID-19. Penelitian ini bertujuan untuk meneliti anosmia dan ageusia sebagai faktor prognosis pada pasien COVID- 19.

Metode: Penelitian ini merupakan studi analitik observasional dengan rancangan kohort retrospektif yang dilakukan di RSUP Sanglah Denpasar pada bulan Januari    hingga Juni 2022.

Hasil: Didapatkan total 1048 subjek dengan 344 subjek mengalami anosmia, 210 subjek mengalami ageusia, serta 474 subjek mengalami kombinasi anosmia dan ageusia. Variabel gejala anosmia maupun ageusia secara statistik merupakan prediktor signifikan untuk kesembuhan pasien COVID-19 (p<0,05). Tingkat kesembuhan pada kelompok pasien bergejala anosmia mencapai 1,8 kali (RR = 1,783, IK 95% = 1,667-1,908) lebih tinggi dan kelompok pasien bergejala  ageusia mengalami kesembuhan 1,6 kali lebih tinggi (RR = 1,564, IK 95% = 1,478-1,655). Setelah disesuaikan dengan variabel lain sebagai perancu, kombinasi gejala anosmia dan ageusia pada pasien menjadi prediktor kesembuhan pasien COVID-19 secara signifikan sebesar 1,5 kali lipat dibandingkan pasien yang tidak mengalami kombinasi gejala anosmia dan ageusia (ARR = 1,523, IK95% = 1,245-1,864, p<0,05).

Simpulan: Anosmia, ageusia, dan kombinasi keduanya menunjukkan adanya faktor  protektif terhadap kemungkinan mortalitas serta menandakan adanya prognosis yang baik pada pasien COVID-19

Background: Asphyxia neonatorum is one of the most frequent perinatal issues caused by preeclampsia, which is one of the most common prenatal disorders. Neonatal asphyxia is one of the health problems that is very important to pay attention to because this condition is associated with perinatal morbidity and mortality. Several maternal conditions are thought to be associated with neonatal asphyxia, including maternal age, gestational age, obstetric history, degree of preeclampsia, and method of delivery. This study aims to confirm this hypothesis.

Methods: This study used an observational analytic design with a cross sectional design conducted between June 2021 and June 2022 at the Department of Obstetrics and Gynecology at Wangaya Hospital Denpasar, 97 pregnant women with preeclampsia were included. The research data were obtained through direct recording from medical records. The data collected were maternal age, gestational age, gravida, parity, history of abortion, degree of preeclampsia and method of delivery.

Results: Pregnant women with preeclampsia who had gestational age <37 weeks [p = 0.021; OR = 3.27 (1,2-8.8)], has a gravida of 1 and > 3 [p = 0.019; OR = 2.97 (1,2-7,1)], has a parity of 1 and > 3 [p = 0.033; OR = 2.62 (1.1-6.1)], had preeclampsia with severe features [p = 0.002; OR = 5.62 (1.7-17.8)], and delivered by SC [p = 0.005; OR = 6.9 (1.5-31.9)] had a higher probability of having a child with asphyxia neonatorum. Meanwhile, the mother's age at delivery [p = 0,516; OR = 0.72 (0.3-1.7)] and history of abortion [p = 0.074; OR = 2.53 (0.9-6.7)] is not a factor that causes asphyxia neonatorum.

Conclusions: Factors related to the incidence of asphyxia neonatorum in pregnant women with preeclampsia are gestational age, gravida, parity, degree of preeclampsia, and method of delivery.

Latar Belakang: Preeklampsia merupakan salah satu penyulit kehamilan yang sangat umum ditemukan dan menyebabkan berbagai masalah perinatal, salah satunya asfiksia neonatorum. Asfiksia neonatorum merupakan salah satu masalah kesehatan yang sangat penting untuk diperhatikan karena kondisi ini terkait dengan morbiditas dan mortalitas perinatal. Beberapa kondisi maternal diduga terkait dengan asfiksia neonatorum, antara lain usia ibu, usia kehamilan, riwayat obstetri, derajat preeklampsia, dan metode persalinan. Penelitian ini bertujuan untuk mengkonfirmasi hipotesis tersebut.

Metode: Penelitian ini menggunakan rancangan analitik observasional dengan desain cross sectional yang melibatkan 97 orang ibu hamil dengan preeklampsia di Departemen Obstetri dan Ginekologi RSUD Wangaya Denpasar periode bulan Juni 2021 sampai Juni 2022. Data penelitian diperoleh melalui pencatatan langsung dari rekam medis. Data yang dikumpulkan adalah usia ibu, usia kehamilan, gravida, paritas, riwayat abortus, derajat preeclampsia dan metode persalinan

Hasil: Ibu hamil dengan preeklampsia yang memiliki usia kehamilan < 37 minggu [p = 0,021; OR = 3,27 (1,2-8,8)], memiliki gravida 1 dan > 3 [p = 0,019; OR = 2,97 (1,2-7,1)], memiliki paritas 1 dan > 3 [p = 0,033; OR = 2,62 (1,1-6,1)], mengalami preeklampsia dengan gambaran berat [p = 0,002; OR = 5,62 (1,7-17,8)], dan bersalin secara SC [p = 0,005; OR = 6,9 (1,5-31,9)] memiliki kemungkinan lebih besar untuk memiliki anak yang mengalami asfiksia neonatorum. Sedangkan usia ibu saat bersalin [p = 0,516; OR = 0,72 (0,3-1,7)] dan riwayat abortus [p = 0,074; OR = 2,53 (0,9-6,7)] bukanlah faktor yang menyebabkan terjadinya asfiksia neonatorum.

Kesimpulan: Faktor yang berhubungan dengan kejadian asfiksia neonatorum pada ibu hamil dengan preeklampsia adalah usia kehamilan, gravida, paritas, derajat preeklampsia, dan metode persalinan